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DSOs: Friend or Foe? · The Millionaire Dentist™

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Speaker 1: Hello, everyone, Welcome to the Millionaire Dentists Podcast, brought to
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Speaker 1: you by four Quadnans Advisory. On this podcast, we break
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Speaker 1: down the world of dentistry, finances and business practices to
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Speaker 1: help you become the millionaire dentists you deserve to be.
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Speaker 1: Please be advised we do speak with an honest tongue
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Speaker 1: and may not be safe for work.
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Speaker 2: Hello and welcome.
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Speaker 3: This is Casey Hires, back to the Millionaire Dentnist podcast
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Speaker 3: in studio with co host Jared Bridgeman.
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Speaker 4: Casey, how are you. It's snowing again today here in Indiana,
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Speaker 4: winter wonderland in the Midwest. Nice, balmy, fifteen degrees yep.
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Speaker 4: And my son keeps wanting to go outside and build
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Speaker 4: snowmen and do all kinds of stuff out there.
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Speaker 2: You know, we're just good for them.
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Speaker 3: We played in the snow, did some sleddings, throwing some snowballs,
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Speaker 3: some tears, the usual.
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Speaker 4: We're throwing tears. Nice when you're playing with your kids,
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Speaker 4: you add rocks to the snowball or no.
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Speaker 3: I just say let's keep it clean. Nothing nothing to
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Speaker 3: the face or the bread basket and real fighting. And
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Speaker 3: I have two little girls, so when I say no,
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Speaker 3: bread basket. All they do is want to throw it
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Speaker 3: up my mid section.
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Speaker 2: Yeah yeah, I mean it's.
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Speaker 5: The biggest part of you. So just kidding, all right,
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Speaker 5: But hey, you know it's the new year.
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Speaker 4: You know, we got all kinds of new things going on,
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Speaker 4: and I'm really you know, I mentioned this every podcast
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Speaker 4: about but you know, we've got a couple events coming
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Speaker 4: up in Jacksonville and Fort Myers. We're going to be
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Speaker 4: in Oklahoma City and Fayetteville, Arkansas. And it's a new year,
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Speaker 4: and you know, new kickoff a new drive, and so
1:30
Speaker 4: at these events, you and your team, you guys present
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Speaker 4: some really important life changing information and tidbits and all
1:38
Speaker 4: kinds of stuff you know that really get either the
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Speaker 4: docs thinking or the docks pissed off that they haven't
1:43
Speaker 4: been doing this already. But I wanted to ask you,
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Speaker 4: you know, we are we're gonna mix it up just
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Speaker 4: a little bit. We're going to add some new information,
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Speaker 4: some new new stuff for the new year, and I
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Speaker 4: wanted to talk to you, being the expert here, you know,
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Speaker 4: can you kind of help me talk to our listeners
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Speaker 4: here and like, what can we expect for the new
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Speaker 4: events coming up?
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Speaker 3: Well, you got to keep things fresh and we take
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Speaker 3: that the heart. Now for our older listeners, John Wooden
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Speaker 3: was a arguably the most successful college basketball coach. Yeah,
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Speaker 3: probably similar to Nick Saban in present day football, right
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Speaker 3: Nick Saban and football, John Wooden and basketball. Guess what
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Speaker 3: they teach all the time? The fundamentals. They don't change.
2:26
Speaker 3: The fundamentals do not change. And just because you have
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Speaker 3: heard something once or twice doesn't mean you are executing
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Speaker 3: it or fully understand it correct and so are the
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Speaker 3: core of our subject matter doesn't change because it's dealing
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Speaker 3: with things that our challenges and dentistry and aren't going anywhere.
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Speaker 4: No, and they're across the board, no matter what city,
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Speaker 4: what rural area, you know, no matter what's going on.
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Speaker 5: Like you know, we have the fund again, the fundamentals that.
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Speaker 3: Everybody overhead, cash flow, tax management, you name it, insurance adjustments,
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Speaker 3: can go on and on and on. That being said,
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Speaker 3: we wanted to add something useful to our audience practice
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Speaker 3: owners around the country. So there's a couple of lightning
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Speaker 3: rod topics we have to choose from, and after some deliberation,
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Speaker 3: we decided to let's jump in and touch on DSOs
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Speaker 3: a little bit more.
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Speaker 2: Dental service organization.
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Speaker 4: That's like and that's you know, obviously anybody listening to
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Speaker 4: this knows what it is about.
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Speaker 5: Corporate dentistry.
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Speaker 3: Yeah, dental service organization is the acronym corporate dentistry. And
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Speaker 3: we said, you know what, there's people that love them,
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Speaker 3: there's people that are indifferent, there's people that dislike them. Right,
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Speaker 3: so why not just shake things up and hit a
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Speaker 3: topic that someone's probably gonna it's going to strike a nerve.
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Speaker 4: We're going to strike a nerve, and it's there. They're
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Speaker 4: you know, you probably know of one in your area.
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Speaker 3: Well, it's an important topic because it's it's been more
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Speaker 3: prevalent and especially the last uh, you know, ten to
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Speaker 3: fifteen years. It's it's everywhere you go to state dental
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Speaker 3: meetings and it's talked about. I mean, it's not just
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Speaker 3: don't usually.
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Speaker 4: Have some kind of flashy booth it No, no, not necessarily,
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Speaker 4: but it's not just some new thing coming. It's here, yes,
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Speaker 4: and so I think it's important to for us to
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Speaker 4: dive in and unpack it.
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Speaker 2: We've been on both.
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Speaker 3: Sides of the deals full disclosure. We try to help
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Speaker 3: the we're entrepreneurial here, we like small business. We like
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Speaker 3: practice owners, we want them to thrive and succeed.
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Speaker 2: That's what we're here for. We were very upfront with that,
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Speaker 2: but we've been on both sides of DSO.
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Speaker 3: Transactions and have learned quite a bit about them, i'd say,
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Speaker 3: over the last five or six years.
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Speaker 5: For the while there was a bit of a mystique to.
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Speaker 3: It, unfortunately there still is, and that's why a lot
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Speaker 3: of our presentation is going to be important. What we're
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Speaker 3: not going to prop it up and we're not going
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Speaker 3: to trash it. We're just going to go through, very
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Speaker 3: unemotionally what we have seen through a national perspective of
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Speaker 3: experience dealing with different ones. The first thing we always
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Speaker 3: hear is, well, this one's different, sure, which then tells
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Speaker 3: me why do you even have to say that, Like
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Speaker 3: there might have been a negative connotation.
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Speaker 5: It's like your mom with her sixth boyfriend? This one's different,
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Speaker 5: is it?
5:14
Speaker 4: Sure?
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Speaker 3: But I'll hear that a lot, right, right, And so
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Speaker 3: ultimately it's let's peel the onion back from uh. You know,
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Speaker 3: you either love it or you hate it, or it's different.
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Speaker 3: You're already defending something, So that's an odd stance. Let's
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Speaker 3: just get into the numbers and look at it. That's
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Speaker 3: what we're gonna do. We're we're going to to bring
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Speaker 3: some objectivity to a lightning rod topic and get into
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Speaker 3: some specifics.
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Speaker 4: So casey, uh, you know you've been in the trenches.
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Speaker 4: You guys have been talking about this, you know, buying
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Speaker 4: closed doors. Where do we start with this? Where's a
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Speaker 4: good starting point for our listeners? Oh, it's that fun word.
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Speaker 3: Everybody likes stowing around at a cocktail party after their
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Speaker 3: second martini.
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Speaker 2: Look at me and my abit.
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Speaker 3: I even have friends who have different business ventures, and
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Speaker 3: when I hear them say it, yeah, my first question
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Speaker 3: is what's it stand for?
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Speaker 4: What's the acronym? And they can get like halfway through
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Speaker 4: and then they just kind of start. But you know,
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Speaker 4: you know, you know, it's like you use.
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Speaker 5: The definition of the word, you're defining it.
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Speaker 2: That's right, you took the words out of my mouth.
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Speaker 2: But that's what it.
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Speaker 3: Does start with, and it is important. It's good to understand.
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Speaker 3: We're going to unwrap that.
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Speaker 5: What does stand for?
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Speaker 3: Well, you know, uh, this is earnings before interest, taxes, depreciation,
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Speaker 3: and amortization. Okay, that's what it means. You know, the
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Speaker 3: earning's part that's profit right revenues minus expenses, interest paid
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Speaker 3: on loans and lines of credit, et cetera. Taxes, any
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Speaker 3: taxes practice pays excluding property and payroll tax depreciation that's
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Speaker 3: an accounting expense on taxes Section one seventy nine YEP
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Speaker 3: amortization accounting it spense that's a typically from an acquisition
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Speaker 3: of the practice I purchased from another doctor.
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Speaker 2: It's not really applicable if it's a startup.
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Speaker 3: That's high level earnings before interest, taxes, depreciation, amortization. It
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Speaker 3: starts there, man, that just rolls right off the tongue.
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Speaker 3: I just like when people bring it up there right
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Speaker 3: friends and social settings, and I'm like, come on, dude,
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Speaker 3: you're big lea gonna be here on my weekend on
7:23
Speaker 3: stuff that I actually turn here, like can we have Yeah,
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Speaker 3: let's come on man anyway. But but it is important
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Speaker 3: if you're a business owner, it's good to know that.
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Speaker 3: Here's why it starts there, because what what happens, just
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Speaker 3: like with anything. Oh wait, I can get six x
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Speaker 3: seven x eight x nine x my ibita Okay, okay,
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Speaker 3: so that's kind of the starting point.
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Speaker 4: I'm just gonna give high level today on it. But
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Speaker 4: that's the starting spot. Well how about that magic calculator.
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Speaker 3: Well, my ibbita is this times ten equals and I
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Speaker 3: see that big number and they're just like boom, that's
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Speaker 3: that My ticket has come in.
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Speaker 2: Two tickets to paradise right there.
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Speaker 3: And you know, listen, first off, anytime you're considering a
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Speaker 3: dso it's a crossroads. That's putting it nicely. Unfortunately, it's
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Speaker 3: a last resort for some. There are times where it
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Speaker 3: is a strategic next step for a variety of reasons.
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Speaker 2: But it is a crossroads.
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Speaker 4: But that ten x number that people like to punch
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Speaker 4: into their magic calculator, here's a couple of things on that.
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Speaker 4: That's more in the past, early on when interest rates
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Speaker 4: were lower, ten x much more common. I'd say it's
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Speaker 4: closer to six to eight x. So that's just that's
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Speaker 4: that's just at the start. When you you know, if
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Speaker 4: you actually know your ribita, looking at your financials and
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Speaker 4: your taxes and things of that nature, you.
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Speaker 5: Know a lot of numbers. I know your ebita.
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Speaker 2: They're right now.
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Speaker 3: That's part of the problem too, right there on the
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Speaker 3: documents that practice owners have that being said, yes, yeah,
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Speaker 3: you know, I'd say a small percentage, maybe thirty percent
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Speaker 3: actually know what the ribbit is, right, That's okay, you're
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Speaker 3: a dentister, a specialist, and you won't bore people at
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Speaker 3: a cocktail party anyway. But that's the first thing is
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Speaker 3: you know, now it's more like maybe six or eight x,
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Speaker 3: so that ten X.
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Speaker 2: Sure, there's always.
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Speaker 3: Exceptions, sure, but what we're trying to do is take
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Speaker 3: a national perspective and generally cover a very complex topic.
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Speaker 2: But what's your RIBBITA And then that six to eight X.
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Speaker 3: Is more common now than that nine or ten x,
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Speaker 3: and interest rates have a big play in that, and
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Speaker 3: it's become more saturated. Used to they were a handful.
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Speaker 3: Right now there's many, many, many, many many more. And
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Speaker 3: so that that's something that a practice owner needs to
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Speaker 3: be cautious of, is getting out the magic calculator, seeing
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Speaker 3: a big number and going all in.
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Speaker 4: It's you know, you can compare it to reselling something
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Speaker 4: you own, something you thought was worth money. And I'd
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Speaker 4: be like, you know, I remember with my grandmother what
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Speaker 4: years back, I'd be like, well this this is kind
10:02
Speaker 4: of make me a big nerd. This action figure is
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Speaker 4: worth one hundred dollars, just like it's only worth a
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Speaker 4: hundred dollars if someone will pay that for you. No,
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Speaker 4: you know, we'll pay that.
10:09
Speaker 2: Yeah.
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Speaker 4: Yeah, So I think there's some similarity there, right, So
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Speaker 4: it kind of makes me think of that whole you know,
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Speaker 4: years ago in college, I actually worked at a pawn shop.
10:18
Speaker 4: Loved that job, but people would come in and bring
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Speaker 4: their stuff and I would have to, you know, kind
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Speaker 4: of guesstimate here's what I think we can sell it for.
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Speaker 5: I want to give you a third of what I
10:28
Speaker 5: think I can sell it for.
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Speaker 2: Okay. I like the example of where you're taking this.
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Speaker 3: The person with the thing they are pawning is worth
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Speaker 3: a lot to them, or potentially more than it is
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Speaker 3: the business who's out to make a profit i e.
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Speaker 3: The pawn shop, i e. The DA So they're in
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Speaker 3: it for profit. And so this leads into again, typically
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Speaker 3: if somebody actually knows the ribbita and does the magic
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Speaker 3: calculator and whatever, I would say, we see it's it's
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Speaker 3: thirty percent less. Yeah, there's a lot of factors we're
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Speaker 3: going to get into on a DSL calculation, but it
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Speaker 3: can be thirty percent plus less than the practice owner
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Speaker 3: thinks it is.
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Speaker 2: So third less.
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Speaker 3: Yeah, that's huge, So right off the jump, the excitement
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Speaker 3: of seeing a big number. There's a lot of factors
11:20
Speaker 3: that play into this, the way things are structured. We
11:23
Speaker 3: get into that a little bit. What's up front, what's in,
11:26
Speaker 3: what's in a company stock, what gets paid out in.
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Speaker 2: You know, like long term profitability by.
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Speaker 5: Ye shareholder loans you're not aware of?
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Speaker 4: Yeah, all kinds of Well that affects yourbit. Yeah, right,
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Speaker 4: because you have to account for it. Yeah, there you go.
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Speaker 3: So you know, just at the jump, don't get blinded
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Speaker 3: by the light. Don't get blinded by the big number,
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Speaker 3: because there's a lot that goes into it.
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Speaker 4: We're going to unpack that in our what we're adding
11:53
Speaker 4: to our our presentation so people have a better understanding
11:58
Speaker 4: before going down the road. People may come to our event,
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Speaker 4: they're going to learn a lot more than just dso's correct. However,
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Speaker 4: they may come away going Okay, now I feel better
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Speaker 4: educated on that. So I'm still going to sell out
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Speaker 4: to a DS or corporate dentistry, but maybe now I
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Speaker 4: know what to look for.
12:14
Speaker 2: A couple questions to ask.
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Speaker 4: Yep, Knowledge is power, you know, having having that the
12:22
Speaker 4: information in your in your AMMO won't hurt you, it's
12:27
Speaker 4: the opposite. You know, people say ignorance is bliss.
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Speaker 5: Haha. You know, this is one of those cases where
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Speaker 5: it's not.
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Speaker 3: Well, the worst, the worst, one of the worst, a
12:34
Speaker 3: terrible outcome would be that you go down this path
12:38
Speaker 3: and then once you finally learn and understand everything, the
12:41
Speaker 3: toothpaste is already out of the tube. It's almost too
12:43
Speaker 3: far down, and you're like, wosh, I wish I would
12:44
Speaker 3: have known that. Yes, now people are going to know
12:47
Speaker 3: that to maybe have those conversations before signing documents that
12:50
Speaker 3: are legally binding and all of those things.
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Speaker 4: But and if they're not the answers you're looking for,
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Speaker 4: you can instead of wasting everybody's time, you can say
12:56
Speaker 4: that's not for me.
12:57
Speaker 5: Now.
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Speaker 3: Time and money your big resources. The reason people go
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Speaker 3: down this route is for a big number. That's the
13:02
Speaker 3: money part. A lot of time can be put into this.
13:04
Speaker 3: So again, this can either help confirm yes, I'm aware
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Speaker 3: and this is the route I want to go, or huh,
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Speaker 3: I have not considered all of these things, right, Well,
13:12
Speaker 3: how do I make.
13:13
Speaker 2: My practice better?
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Speaker 3: Well, that's the rest of our presentation is how we
13:17
Speaker 3: get into how to make your ibbit a better not
13:21
Speaker 3: for cocktail party's sake, or to sell to a dso,
13:23
Speaker 3: but because you want a very profitable practice that's efficient
13:26
Speaker 3: on your terms.
13:27
Speaker 4: And you want more money in your pocket and then
13:28
Speaker 4: your make account. You keep your spouse happy, keep those
13:31
Speaker 4: kids happy.
13:32
Speaker 1: You know.
13:33
Speaker 3: There you go. You know we're we're speaking at the
13:36
Speaker 3: Yankee Gental Congress later this month. I'm not going to
13:38
Speaker 3: touch on this topic. We're going to stick to well
13:42
Speaker 3: the presentation we set months ago. And yes, those fundamentals again,
13:47
Speaker 3: the sports analogy. The fundamentals and sports do not change.
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Speaker 3: You must master those before becoming an advanced player. End
13:54
Speaker 3: up as a practice owner. You unless you're okay being
13:58
Speaker 3: on a hamster wheel making and saving very much and
14:00
Speaker 3: being stressed out. And again, she's not what you want.
14:02
Speaker 3: If you want to achieve something, the fundamentals must be executed.
14:05
Speaker 5: Yeah, you know that makes me think.
14:07
Speaker 4: I started to bring this up last week and I
14:10
Speaker 4: had to fill in and coach my seven year old
14:12
Speaker 4: son's basketball team.
14:13
Speaker 5: And I'm undefeated as a head coach in basketball.
14:16
Speaker 2: Look at you.
14:16
Speaker 4: I just want to put that out there so if
14:17
Speaker 4: any colleges want to hire me, and I'll pay me
14:19
Speaker 4: a couple of meal.
14:20
Speaker 2: Now did they have officials?
14:22
Speaker 5: It was me and the other coach.
14:23
Speaker 2: Well did you get along with the other coach?
14:26
Speaker 4: We did?
14:26
Speaker 5: I mean I may have tripped his kids on quote
14:28
Speaker 5: unquote accident.
14:28
Speaker 2: If you didn't, Yeah, some dirty pool.
14:32
Speaker 5: This is all, you know.
14:33
Speaker 4: Very fascinating because you and I sit here and we've talked,
14:36
Speaker 4: and I'm very aware of what DSOs are, and even I,
14:40
Speaker 4: in my infinite wisdom here didn't know even some of this. Now,
14:44
Speaker 4: it's really great to see these numbers put into place.
14:47
Speaker 4: Besides coming to one of our events, which we're coming
14:51
Speaker 4: to a lot of areas this year, you really should come.
14:53
Speaker 4: Not only are you going to learn a lot of
14:56
Speaker 4: good and I'm gonna say good shit, you're also going
14:58
Speaker 4: to have a good time with your peer. There's food,
15:00
Speaker 4: there's usually bourbon involved. If you don't drink, we've got
15:03
Speaker 4: all kinds of sodas I'm assuming a.
15:06
Speaker 3: Mocktails are all cocktails? Yeah, mocktails. No, we put on
15:09
Speaker 3: nice events. People are going to have a good evening
15:10
Speaker 3: regardless and typically learn a little something.
15:13
Speaker 4: But this is one of those times that I think
15:16
Speaker 4: you're going to walk away with information that is, as
15:20
Speaker 4: we often say, not tied emotionally. If you go and
15:23
Speaker 4: talk to a ds O, yeah, they're going to talk
15:25
Speaker 4: up their own stuff and tell you that they're they're
15:27
Speaker 4: here to pave your roads with gold or whatever it comes.
15:29
Speaker 3: And like we've said, our business model, we can't help everybody.
15:32
Speaker 3: We're not a volume shop. Our idea is to educate
15:35
Speaker 3: the dental community, turn that into action, and will help
15:38
Speaker 3: some people along the way if it's a right fit.
15:40
Speaker 3: But I mean, we talked to somebody recently. Again they
15:43
Speaker 3: were pretty convinced that the DSL route was where they
15:46
Speaker 3: wanted to go, and by the end of some basic
15:50
Speaker 3: conversations went, oh my gosh, I can't believe I almost
15:53
Speaker 3: did that. Now that being said, we have also had
15:55
Speaker 3: clients who we help them sell to a ds SO
15:59
Speaker 3: because in their unique situation, when you're a custom firm,
16:03
Speaker 3: that was the best option. And so when I say
16:06
Speaker 3: both sides of it, we are on both sides of it.
16:08
Speaker 3: We have seen this from both lenses, not just one.
16:11
Speaker 4: Yeah, how many times have you spoken to maybe a
16:14
Speaker 4: retired dentist or somebody you know along those lines who
16:17
Speaker 4: sold to a DSL and said, damn, I wish I
16:19
Speaker 4: had met you guys, well before I'm assuming it kind
16:23
Speaker 4: of happens.
16:23
Speaker 3: Yeah, I know that that happens a lot people that
16:25
Speaker 3: have that have retired, they're retired, they go there, they
16:28
Speaker 3: go to an event, and they go ow. I wish
16:29
Speaker 3: I would have had someone like you helping me during
16:31
Speaker 3: my career. Take dso out of it or huh. I
16:35
Speaker 3: didn't know there were other options. I thought I just
16:37
Speaker 3: was sort of less resort sort of thing. But Casey,
16:42
Speaker 3: thank you so much for coming today again. If you
16:44
Speaker 3: folks want to hear more about this topic as well
16:46
Speaker 3: as all the fundamentals and things that really need to
16:49
Speaker 3: be strengthening practices, we're gonna again. We're gonna be all
16:52
Speaker 3: over the country. Go to four quadrants advisor dot com,
16:54
Speaker 3: slash events. Check us out there.
16:57
Speaker 4: If you have a friend who who's also a practice
17:00
Speaker 4: owner or an associate, whatever, send them a link, let
17:02
Speaker 4: them know we're here, passing the podcast, give us some reviews, all.
17:06
Speaker 5: Kinds of anything you can do to help yourself.
17:10
Speaker 4: And you in your family and your friends out would
17:11
Speaker 4: be great. Casey, I know you're excited about going to
17:14
Speaker 4: Fort Myerson. Get out of this now.
17:17
Speaker 3: Yeah, yeah, yeah, it's gonna be a nice little tease there.
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Speaker 3: A couple of days in and out, though I'm not
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Speaker 3: extending my trip, not too much.
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Speaker 4: I've got to come back a month later. I've got
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Speaker 4: to help coach some youth basketball. Yeah, we're the coach
17:30
Speaker 4: twins and go over the fundamental.
17:31
Speaker 2: That's right, Thanks Casey.
17:35
Speaker 1: Hello everyone, Welcome to the Millionaire Dentist Podcast, brought to
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